Provider Demographics
NPI:1851011761
Name:HENDRICKS CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:HENDRICKS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DYLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-554-3890
Mailing Address - Street 1:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:MILLTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:54858-0425
Mailing Address - Country:US
Mailing Address - Phone:715-825-2873
Mailing Address - Fax:
Practice Address - Street 1:202 MAIN ST W
Practice Address - Street 2:
Practice Address - City:MILLTOWN
Practice Address - State:WI
Practice Address - Zip Code:54858-9028
Practice Address - Country:US
Practice Address - Phone:715-825-2873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-31
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty